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Lamictal (400 mg) and breastfeeding

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  • Lamictal (400 mg) and breastfeeding

    I know this question was already asked about 200mg, but I was wondering if there was a difference when raised to 400mg. I take 200mg twice daily for my epilepsy, so I can't decrease it at all. I have a 9 month old, and at 2 weeks old (when I was breastfeeding) she developed a rash so I asked her pediatrician if it was a normal one. I was worried that it was a side effect from the Lamictal. He said it was a normal rash but he suggested I stop breastfeeding for the time being. He suggested switching to a more proven "safe" epilepsy/breastfeeding medicine, but I'd been on Lamictal for 6 years at that point, so I wasn't comfortable switching medicine and risking a seizure. So I just stopped breastfeeding cold-turkey. Now, we're planning on trying for our second baby soon, and after doing some more research it seems that Lamictal is safer than I thought. I'm really really hoping to breastfeed all future children so I wanted to ask this as soon as possible. Thank you!

    Also, does taking Folic Acid help balance out the medicine?
    Last edited by hannanoel; 10-12-2012, 02:42 PM.

  • #2
    Hannanoel:

    You are correct, we have a lot of good data now on Lamotrigine, and the outcome appears good both in use during gestation, and during breastfeeding. Neonatal levels are slightly high immediately after birth, but drop quickly by 1 month of age. I'd suggest you continue on with your Lamictal as you are doing and breastfeed your infant.

    Tom Hale Ph.D.

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    • #3
      Is there anything I should specifically watch for? Or any other things I should do? I saw one post about getting the infant's levels checked.

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      • #4
        Hannanoel:

        Somnolence or sedation is the primary side effect of lamotrigine. If you see a severe widespread rash in mom or the infant, stop breastfeeding. Very rarely, patients who are consuming lamotrigine have a severe immune reaction to this drug. Again, it is very very rare.

        As for folic acid, you only need about 1 mg per day. This anticonvulsant does not apparently affect folic acid levels like many of the others.

        In my opinion, lamotrigine is one of the best most ideal anticonvulsants to use in pregnant and breastfeeding mothers. But this is totally dependent on the type of seizure disorder that is being treated.

        Tom hale Ph.D.

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        • #5
          Do maternal and infant serum levels need to be monitored if a mother is breastfeeding and taking Lamotrigine?
          Dose is 300 mg and soon to be weaned to 250mg
          Thanks
          Suzanne Bussetti, CPNP

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          • #6
            Hi, thanks for your post.

            Lamotrigine has a narrow therapeutic index and multiple sources recommend monitoring the mother's drug levels to ensure her safety. This is at the physician's discretion, of course. We feel it is not necessary to monitor the baby's drug levels routinely, but this test will help with the differential if symptoms arise that could plausibly be the result of lamotrigine exposure.

            For anyone reading this, please post again or call us at the InfantRisk Center, (806)352-2519, if this has not completely answered your question. I would also appreciate you filling out a 2 minute survey about your time on the forum:

            https://tthsclubbock.co1.qualtrics.com/SE/?SID=SV_bJzhyKVSivVkQZL&Counselor=Web

            -James Abbey, MD

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